Migrants mental health at the RSM

When it comes to various psychiatric illnesses migrants suffer more from conditions including depression and anxiety than the indigenous population of the new country. But it is hard to generalise because migrants are not a homogenous group and people may migrate for all sorts of reasons from political to personal, economic and social. The pop singer Madonna is a migrant as she moves between her million pound homes in different countries throughout the world but her experience on private jets with VIP treatment is very different from that experienced by the economic migrant who is seeking a better life.

There are many reasons why many new migrants may feel that their mental health is challenged, even though, as a group, they are particularly resilient. They need to be to survive the physical and psychological impact of migration.

Firstly, recent migrants may suffer from a sense of cultural bereavement, grieving for what they have left behind.  For some migrants, such as asylum seekers, they may have been forced out of their home country due to the threat of violence or persecution due to tehri religious or political beliefs, so they also feel that their displacement is not their choice.

Cultural conflict can also lead to mental health problems.  Many people arrive in a new place and find that they are not welcomed by the indigenous population and the country is very different to what they expected. They may feel that they have been misled and let down. There may also be hostility towards cultural norms and behaviour that was normal at home.

Culture shock is a phenomenon that has been described by anthropologists and results in new migrants retreating into themselves or responding in an aggressive manner to the new country which appears to be unfriendly and unfamiliar. Even not being able to find the kind of food you had at home can trigger feelings of alienation. In surveys, nine out of 10 migrants say that they miss the diet and food of their home country.

Migrants may have more proportionally more psychiatric disorders which may be related to minority stresses but they are also less likely to successfully access services. They may not know they need to register with a GP and in the UK, GPs are gatekeepers to specialist mental health services. 

Or they may believe that healthcare is too expensive.  In their home countries, they may not have had a free health care system similar to the NHS. In some communities, mental ill- health may be blamed on witchcraft or the Evil Eye and sufferers end up going to  spiritual healers or shamans. Those migrants who do not have the right papers may be too afraid to go to a NHS doctor in case they are reported, even if this isn’t true. If you are an asylum seeker, for example, you are entitled to free care on the NHS.

50 years ago, the British Council used to organise events to teach migrants about the culture, environment and diet of the UK to people who were planning to come here but those days are gone and there is less instruction and education to help people find their feet.
Mental illnesses can also occur many years after someone has first entered their new home country. There are not many good quality studies looking at mental health issues among migrants and duration of stay, but according to a study published 75 years ago looking at how Norwegians assimilated into the USA, 50 per cent of mental health problems only occur ten years after the migration date.  More recent studies have looked at the rate of mental health issues among different ethnic groups and these consistently show that the rate is schizophrenia is much higher among African-Carribbean migrants than indigenous white population and similar results are also reported from the Netherlands, Sweden and Denmark. When it comes to depression among migrants from Pakistan and Bangladesh, there are interesting differences too and Bangladeshis are more likely to suffer than people from Pakistan. However, are we asking the right questions in these studies? For example, there is no word for depression in Punjabi or Urdu so are we getting answers that correspond to the intended question?

There is no doubt that migrants from these countries may experience institutional or personal racism and may have to deal with differences between their expectations and actual achievements. After all, how many doctors or lawyers in Pakistan or Bangladesh have had to accept the trade of a taxi driver or a fitter in the UK? That disparity alone can push people into feelings of failure and depression.

Professor Dinesh Bhugra CBE, consultant psychiatrist and President Elect of the BMA, is talking at the RSM meeting Migrant mental mealth; rights, access and advocacy to be held in London on the 23^rd June 2018.